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THE FORCES OF CHANGE IN HEALTH CARE

Bernard J. Healey

LEARNING OBJECTIVES

After reading this chapter you should be able to

• Understand the need for real change in the way health care services are produced and delivered to consumers.

• Be aware of the changes in health care that will result from passage of the Patient Protection and Affordable Care Act of 2010.

• Understand the value of using concepts from economics to determine the value of various medical procedures.

• Describe why better use of technology would improve health care delivery.

Tremendous changes are rapidly engulfing the entire health care sector of the U.S. economy. These changes are a direct result of a very strong effort by the federal government to gain control of escalating costs in the delivery of health care to Americans. These cost increases, on an annual basis, are far above the inflation rate in the American economy. Policymakers have finally come to the full realization that cost escalation in health care has become a drag on the economy, has bankrupted many hard-working Americans, and is no longer sustainable. Americans need a health care system with decreased costs for increased quality of care.

There are many who believe that the United States has the greatest health care system in the world. However, this belief is not supported by the majority of health care indices, which reveal that the United States ranks quite low when compared to other countries on many important measures, including individual life expectancy and infant mortality rate. The World Health Organization (WHO) (2013) points out that the United States spends much more than any other country on health care services but is only thirty-seventh out of 191 countries in the WHO's ranking of health care delivery systems, based on a range of measures. It is reported that the United States spends twice as much as other industrialized countries on health care delivery, yet all this spending results in inferior health outcomes for its population. To be sure, in many ways the U.S. system of health care offers a superior array of advanced and expensive curative medical care. Unfortunately, this medical care system does a very poor job of keeping people from becoming ill in the first place. This is the reason why the winds of change directed at the U.S. system of health care are so strong. Changes to the U.S. system will require a united effort by government, the providers of health care services, employers, and even consumers to develop a new system that concentrates scarce resources on good health outcomes, rather than on wasteful, unproductive activities of low marginal value.

Schimpff (2012) argues that several medical megatrends are emerging that will result in changes in the practice of medicine over the next few years. All told, they will create five shifts in medicine:

1. An increase in custom-tailored medicine

2. A greater emphasis on prevention

3. An improvement in the ability to repair, restore function to, or replace organs, tissues, or cells

4. Fully digitized medical records available instantly, anytime or any place

5. An enhanced level of safety and quality of care (p. 42)

This chapter will consider the effects of shifts 2, 4, and 5, focusing especially on the chronic disease epidemic, cost-effectiveness analysis, and health promotion and disease prevention as the factors most likely to foster real change in the near future.

 
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